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Q: I had a severe allergic reaction to the antibiotic moxifloxacin (Avelox). I was prescribed the antibiotic for a bacterial infection in my blood. A rash developed on my arms and stomach, and I continued to take the medication on the advice of the local doctor (I was in the Bahamas at the time), who said I should continue as long as I could tolerate the side effects.
Even though I only took 4 pills over 4 days the rash took over my entire body and it looked like I had been burned severely by a sun lamp. I was hospitalized for 3 days with IV medications. My skin peeled several times over; it was itching, burning, and very painful. I felt as though I'd been burned from the inside out!
Now, more than a month later, my skin is better but I still itch and burn, and I am still taking 10 mg of prednisone. Why am I still experiencing these symptoms? Surely the antibiotic is cleared out of my system by now? What is the right treatment?
A: It sounds like you had "toxic epidermal necrolysis," or a severe version of Stevens-Johnson syndrome, which is, exactly as you say, a very severe allergic reaction. This is a rare side effect of antibiotics and other medications: only 2 cases occur per million people per year.
No one knows why people develop this reaction, although persons with compromised immune systems are at risk more than others. And there is no way to predict it: about 1% to 2% of people have a rash when they use moxifloxacin, but, again, very severe reactions are rare.
The treatment for this condition is mainly supportive, that is, making sure patients are hydrated and free of skin infections and treating the wounds. Medications, such as the prednisone you're on, are often tried, but because the condition is rare, no one is quite sure what is helpful.
Most people take three weeks to heal the wounds but symptoms (itching and burning) may continue well beyond that. These are symptoms of reconstructing skin and nerves. As you suspected, the antibiotic left your system about 3 days after your last dose.
The best thing you can do is give yourself rest to allow your body to heal, and never take moxifloxacin (or a similar antibiotic) again!
Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.
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